Be Brave Bears

Nominate...

Note: Multiple nominations are permitted, but should be completed as one nomination per form. If you wish to nominate multiple children, please complete one form per nominee.

Your Name:

Your profession (if applicable):

Child’s Delivery Address:

Postcode:

Country:

Telephone:

Mobile:

Email Address:

Confirm Email Address:

Child’s Name (including surname):

Child’s Date of Birth (DD/MM/YYYY):

Child’s Sex:

Relationship to Child:

Child’s parent/guardian’s email (if different):

Child’s parent/guardian’s telephone (if different):

Why would you like to nominate this child? Please give us a description of their medical conditions:

Tell us a bit about the child, their personality, what they like doing and any hobbies they enjoy:

Hospital / Hospice supporting child:

Child’s health status (to enable us to prioritise bears):

First Choice Bear:

Second Choice Bear:

Third Choice Bear:

Delivery:

Collection

Deliver to Hospice / Hospital

Deliver to Home Address

By applying for a Be Brave Bear you agree to allow us to share your nomination on our website and social media platforms in order for us to attract a sponsor for your bear.

I agree

Decline - I am willing to wait until a sponsor becomes available

Decline - I will self sponsor this bear (Please complete the sponsor here, to enable your application to commence)

Where did you hear about us?

Office Ref (if applicable):

If you have a social media page for your child's journey that you'd like us to share, put the link here:

If you would like to send photos of your child to help us attract a sponsor, do so here:

I understand that there is a £5.00 P&P charge: